Jerman Alexander, Lindič Jelka, Škoberne Andrej, Borštnar Špela, Martinuč Bergoč Maja, Godnov Uroš, Kovač Damjan
Clin Nephrol. 2017;88(13):101-108. doi: 10.5414/CNP88FX23.
Complex and longstanding bone disease superimposed by harmful influences of immunosuppression is the reason for increased risk of bone fracture in kidney transplant recipients. The aim of our study was to analyze the incidence and prevalence of nonvertebral bone fractures and early (in the first post-transplant year) clinical and laboratory risk factors for suffering bone fracture in the long-term post-transplant period.
Clinical and laboratory data as well as bone mineral density (BMD) measurements of 507 first kidney transplant recipients who were transplanted in the period from 1976 to 2011 were analyzed.
The mean age of included patients was 54.3 ± 12.0 years, there were 45% females, and mean time on renal replacement treatment prior to transplantation was 63.4 ± 43.6 months. The average observation time post-transplant was 9.7 years (1.4 - 36.3 years). Post-transplant, 64 (12.6%) patients suffered 89 nonvertebral fractures (44 patients suffered 1 fracture, 15 patients 2 fractures, and 5 patients 3 fractures). Patients with fractures had significantly lower late BMD of femoral neck in the period of 1 - 10 years post-transplant, had osteopenia and osteoporosis more frequently in the same time period, and higher serum alkaline phosphatase in the first year post-transplant. 13 patients (13/64, 20.3%) had major fractures. Patients with major fractures were significantly older than patients with no major fractures and had lower serum albumin. Frequency of treatment with bisphosphonate, calcium, or phosphate did not differ between the groups. Vitamin D supplement (active form in 98% of cases) was prescribed more frequently in the group without fractures, but this was not statistically significant.
CONCLUSION: Fracture rate in our transplant patient population was comparable to that reported in the literature. Except for a higher level of serum total alkaline phosphatase in the fracture group, we found no other early laboratory risk factors for bone fractures. BMD at the femoral region 1 - 10 years after kidney transplantation but not BMD at the time of transplantation was a risk factor for nonvertebral fractures. Osteopenia and osteoporosis in the post-transplant period were found to be a fracture risk factor. .
复杂且长期存在的骨病叠加免疫抑制的有害影响，是肾移植受者骨折风险增加的原因。我们研究的目的是分析非椎体骨折的发病率和患病率，以及长期移植后期（移植后第一年）发生骨折的临床和实验室风险因素。
分析了1976年至2011年期间接受首次肾移植的507例患者的临床和实验室数据以及骨密度（BMD）测量结果。
纳入患者的平均年龄为54.3±12.0岁，女性占45%，移植前肾脏替代治疗的平均时间为63.4±43.6个月。移植后的平均观察时间为9.7年（1.4 - 36.3年）。移植后，64例（12.6%）患者发生了89例非椎体骨折（44例患者发生1处骨折，15例患者发生2处骨折，5例患者发生3处骨折）。骨折患者在移植后1 - 10年股骨颈的晚期骨密度显著较低，在同一时期骨质疏松症和骨质减少症的发生率更高，且移植后第一年血清碱性磷酸酶水平更高。13例患者（13/64，20.3%）发生了严重骨折。发生严重骨折的患者比未发生严重骨折的患者年龄显著更大，血清白蛋白水平更低。两组间双膦酸盐、钙或磷酸盐的治疗频率无差异。未发生骨折的组更频繁地开具维生素D补充剂（98%的病例为活性形式），但这无统计学意义。
我们移植患者群体中的骨折发生率与文献报道相当。除了骨折组血清总碱性磷酸酶水平较高外，我们未发现其他早期骨折的实验室风险因素。肾移植后1 - 10年股骨区域的骨密度而非移植时的骨密度是非椎体骨折的风险因素。移植后骨质疏松症和骨质减少症被发现是骨折风险因素。
